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The ABR and You:A Lifelong and Not So

Complicated Relationship

Anthony L. Zietman, MD, FASTROABR Assistant Executive Director for Radiation

Oncology

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Objectives

1. The board system: who, what, why

2. Initial certification

3. The changing landscape

4. Maintenance of certification: why, how, benefits

5. How they do it elsewhere

6. Losing certification

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The Board System

The original boardsOpthalmology, ENT, Ob Gyn, Derm/syph

ABMS formed 1934 – coordinate and standardize

Currently 24 boards under the ABMS>90 subspecialties

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Initial Certification

Biology, Physics – PGY4

Clinical – PGY 5

Orals – PGY 6

Who passes orals?

Board eligibility? – 6 years and out

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Initial Certification

Oral Exam

• To continue

• Case-based and image-rich

• Standardized and calibrated

• Louisville

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The age of physician power:

The linear practice of medicine

Med

School

Residency

Practice

Lic

en

sin

g e

xa

ms

Re

tire

me

nt

Bo

ard

ex

am

s

New

gizmos

or drugs

New

techniques

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Patient and Payer Power

Want physicians who:

• use treatments that are effective and improve outcomes

• are competent and strive to improve their practice

• are safe

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Evidence

90

10

20

30

40

50

60

70

80

90

UME GME 1 Yr 5 Yr 10 Yr 15 Yr 20 Yr 25 Yr Retire

Doctor X

MinimalStandard

Competence

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Safety

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Maintenance of CertificationWhy?

• Patients demand it

• Hospital demand it

• Payers demand it

• 1940s discussions began

• 1960s Int Med (voluntary), Family Practice (mandatory)

• 1998 All boards

Who?

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Maintenance of CertificationComponents

Four parts:

I. Professional standing - Licensure

II. Lifelong learning – CMEs: 1/3 self assessment component

III. Cognitive examination

IV. PQI projects

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Maintenance of CertificationTiming

Formerly: 10 year cycle

Now: Continuous “rolling” certification

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Continuous Certification (ConCert)Why?

• Pressures on the “old” MOC program

• CMS: MOC:PQRS Incentive

• American Board of Medical Specialties (ABMS): MOC Public reporting (meeting/not meeting/not required)

• Federation of State Medical Boards:

Maintenance of Licensure (MOL)

• Credentialing and privileging bodies

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So what is ConCert?• Really, a new reporting regimen to assist diplomates

in meeting program requirements• Certificates issued in 2012 and after will no longer

have “valid through” date – instead continuing certification will be contingent on meeting MOC requirements

• Annual look-back used to determine MOC participation status.

Part I continuous Part II and Part IV previous 3 years Part III previous 10 years

• MOC requirements and fees unchanged

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Yearly Progress

Part I: Valid licensure

Part II: 25 CME with 1 SAM

Part III: Exam q 10 years

Part IV: 3 projects q 10 years

Part I: Valid licensure

Part II: 25 CME with 8 SA-CME

Part III: Exam q 10 years

Part IV: 1 project q 3 years

10-Year System ConCert

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2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Part 3: Exam passed within previous 10 years

Part 4: 1 PQI completed within previous 3 years

Part 2: 75 CME completed within previous 3 years, at least 25 of which are SA-CME

Part 1: At least 1 valid state medical license

Annual Look-back

(March)

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2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Part 3: Exam passed within previous 10 years

Part 4: 1 PQI completed within previous 3 years

Part 2: 75 CME completed within previous 3 years, at least 25 of which are SA-CME

Part 1: At least 1 valid state medical license

Annual Look-back

(March)

2013 credits will not

count towards 2017 totals

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2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Part 3: Exam passed within previous 10 years

Part 4: 1 PQI completed within previous 3 years

Part 2: 75 CME completed within previous 3 years, at least 25 of which are SA-CME

Part 1: At least 1 valid state medical license

Annual Look-back

(March)

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Advantages of Continuous Certification

• The number of CME and self-assessment CME credits (SA-CME) counted per year is unlimited

• You may take the MOC exam at any time, as long as the previous MOC exam was passed no more than 10 years ago

• Built-in “catch-up” period of one year – still certified

• Aligns reporting more closely with CMS, TJC, credentialing and state licensing boards

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Part II: SAMs and SA-CME

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SAM and SA-CME

• SAMs– Primarily in-person CME activities that count as SA-

CME

• SA-CME– All “enduring” Category 1 CME activities

– “Enduring” activities include journal CME, CD/DVD, archived webinars, podcasts

• Reporting– Automatically: ASTRO Gateway feed to ABR

– Self-entered: Log in to myABR and record

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Part IV: Practice Quality Improvement (PQI)

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PQI: Things to keep in mind

• PQI does not require IRB approval or publication

• PQI can be done as individual or as a part of a group or practice

– Individual and Group MOC participation templates available on the ABR website

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PQI Essential Elements1

• Select project, metric(s), and goal

• Collect baseline data

• Analyze data

• Create and implement improvement plan

• Re-measure

• Self-reflection

1Retain documentation on project in the event of a random MOC audit

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DO

STUDYACT

PLAN

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Individual Project Example #1Project Title: Breast Cancer: Hormonal Therapy for Stage IC - IIIC Estrogen Receptor/ Progesterone Receptor (ER/PR) Positive Breast Cancer

Project Description: Percentage of female patients aged 18 years and older with Stage IC through IIIC, ER or PR positive breast cancer who were prescribed tamoxifen or aromatase inhibitor (AI) during the 12-month reporting period.

Baseline Data Collection (Numerator): Number of patients who were prescribed tamoxifen or aromatase inhibitor (AI) during the 12-month reporting period.

Data Analysis: analyze data

Improvement Plan & Implementation: create and implement an improvement plan to address the root cause performance

Re-measure: gather additional data using baseline data criteria

Self-reflection: short statement describing how the project outcome has impacted clinical practice.

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Individual Project Example #2

Project Title: Oncology: Medical and Radiation – Pain Intensity Quantified

Project Description: Percentage of patient visits, regardless of patient age, with a diagnosis of cancer currently receiving chemotherapy or radiation therapy in which pain intensity is quantified.

Baseline Data Collection (Numerator): Patient visits in which pain intensity is quantified.

Data Analysis: analyze data

Improvement Plan & Implementation: create and implement an improvement plan to address the root cause performance

Re-measure: gather additional data using baseline data criteria

Self-reflection: short statement describing how the project outcome has impacted clinical practice.

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Individual Project Example #3Project Title: Documentation of Urinary, Bowel, Sexual function at baseline

Project Description: Complete documentation of urinary and sexual function (ideally with IPSS and SHIM scores) and of bowel function is essential to determine the role of radiation in the management of prostate cancer and to determine the rorole of role of radiation in subsequent symptoms seen at follow-up.

Data Analysis: Collect data

Improvement Plan & Implementation: create and implement an improvement plan to address the root cause performance

Re-measure: gather additional data using baseline data criteria

Self-reflection: short statement describing how the project outcome has impacted clinical practice.

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Group PQI Project Participation

• Group participation PQI requirements are very similar to individual project requirements and include:– at least 2 or more ABR diplomates– identification of a team leader – at least 3 team meetings (kick-off, data and root cause

analysis, improvement plan development)

• Individuals may participate in group PQI projects and receive credit. “Meaningful participation includes:– attending at > 3 team meetings– completing a personal self-reflection– attesting to project completion on myABR– securing access to project records (in case of audit)

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Lapse/Loss of Certification

Lapse• “Fall off cliff”• Out of clinical practice – illness, administration

Retire

Lost• Certification follows license

Re-entry

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The UK Experience

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The UK Experience

Everything that the US has plus a portfolio containing:

• Log of all significant events

• Feedback from patients

• Feedback from peers

• Review of complaints and compliments

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The UK Experience

Annual review by a revalidation officer with the following supporting documents:

• Statement of scope of practice

• Statements of probity and health

• Goals for coming year

• Supporting information drawn from daily practice

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Conclusions

The relationship with the ABR is lifelong

• It can be incorporated into your working life

• It is relevant to your working life

• It will become essential if you are to remain credentialed, on insurers lists, and be paid

• For overburdened physicians it may feel like a “final straw” but really it isn’t